This form is based on the model form at 12 C.F.R. pt. 226 app. H, clause H-8.
Truth-in-Lending Notice of Right of Rescission
[Notice of Right to Cancel—General]
[Identification of transaction]
Your Right to Cancel
You are entering into a transaction that will result in a [mortgage on/lien on/security interest in] your home. You have a legal right under federal law to cancel this transaction, without cost, within three business days from whichever of the following events occurs last:
1.the date of the transaction, which is [date]; or
2.the date you received your Truth-in-Lending disclosures; or
3.the date you received this notice of your right to cancel.
If you cancel the transaction, the [mortgage/lien/security interest] is also canceled. Within twenty calendar days after we receive your notice, we must take the steps necessary to reflect the fact that the [mortgage on/lien on/security interest in] your home has been canceled, and we must return to you any money or property you have given to us or to anyone else in connection with this transaction.
You may keep any money or property we have given you until we have done the things mentioned above, but you must then offer to return the money or property. If it is impractical or unfair for you to return the property, you must offer its reasonable value. You may offer to return the property at your home or at the location of the property. Money must be returned to the address below.
If we do not take possession of the money or property within twenty calendar days of your offer, you may keep it without further obligation.
How to Cancel
If you decide to cancel this transaction, you may do so by notifying us in writing, at [creditor’s name and business address].
You may use any written statement that is signed and dated by you and states your intention to cancel, or you may use this notice by signing and dating the notice of cancellation below. Keep one copy of this notice because it contains important information about your rights.
If you cancel by mail or telegram, you must send the notice not later than midnight of [date] (or midnight of the third business day following the latest of the three events listed above). If you send or deliver your written notice to cancel in some other way, it must be delivered to the above address no later than that time.
In this agreement “you” and “your” refer to the consumer, and “we” and “us” refer to the creditor.
Consumer acknowledges receipt of the completed Truth-in-Lending Notice of Right of Rescission.
Consumer’s signature
Date:
Notice of Cancellation
I WISH TO CANCEL.
Consumer’s signature
Date: